Provider Demographics
NPI:1023743663
Name:THATCHER, KIM THIEN
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:THIEN
Last Name:THATCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44791 W JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-4190
Mailing Address - Country:US
Mailing Address - Phone:714-395-3904
Mailing Address - Fax:
Practice Address - Street 1:44150 W MARICOPA CASA GRANDE HWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5900
Practice Address - Country:US
Practice Address - Phone:520-568-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA139622355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant